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PurposeVirtual grocery shopping (VGS), or online grocery shopping, traditionally has seen slow adoption in Canada; however, the COVID-19 pandemic has forced consumers to seek safer ways to shop. Retailers have invested in building new infrastructure to meet the current consumer demands for VGS. However, the main driver for VGS behaviour has not been yet clearly identified. Additionally, it is also not unknown whether the shopping modalities will continue VGS after the pandemic. This study provides insights into consumer intentions to use VGS by extending the model of goal-directed behaviour (MGB) to incorporate consumer technological readiness.Design/methodology/approachThe study collected 935 valid survey responses from an online survey panel of Canadian consumers. A two-step approach was applied to analyse the data, comprising confirmatory factor analysis (CFA) and structural equation modelling (SEM). The data quality and model fit were tested before testing the proposed relationships among the constructs: attitude, subjective norm, perceived behavioural control, positive and negative anticipated emotions, as well as technological readiness, desire and behaviour intentions. The mediation role of desire between frequency of past online grocery shopping behaviours and the future behavioural intention was also tested using SPSS PROCESS.FindingsThe study results showed that attitudes, subjective norms, perceived behavioural control, positive and negative emotions, technological readiness and frequency of past VGS have a major impact on consumers' desire to embrace VGS in the future. Consumer desire also played a significant mediating role between frequency of past VGS behaviours and future shopping intention online. In addition, the frequency of past VGS showed an even stronger impact on behavioural intention among female consumers than among male consumers.Originality/valueThe findings of this study provide an original insight into the social, cultural and psychological factors that impact consumers' use of VGS, particularly the impacts of gender.

Bispecific T-cell engagers (TcEs) are antibody-based immunotherapeutic drugs that specifically direct lymphocyte effector functions against tumors. TcEs have one arm with affinity for an activating immunoreceptor connected through a flexible hinge to a distinct arm with affinity for a tumor antigen to achieve tumor killing by cytotoxic immune cells. Understanding the structure-function relationships between TcE architecture, immunological synapse formation and function could accelerate design of new TcE-based cancer therapies. Here, we engineer and systematically characterize TcE formats with antigen binding antibody fragments or single chain variable fragments linked together incisthrough immunoglobulin G1 hinge or intransacross the antibody constant fragment. The TcEs were tested in CD8+T-cell killing of Her2+breast cancer cells and evaluated by high-content imaging of immunological synapse formation on a supported lipid bilayer (SLB) platform. We find thatcisTcEs perform better than atransTcE for T-cell mediated killing. Quantification of synapse formation dynamics revealed that all threecisTcEs tested, created close contacts of < 16 nm leading to rapid synapse formation and integrin activation. In contrast, thetransTcE formed close contacts averaging ≥ 16 nm and formed synapses more slowly with weaker integrin activation. We conclude that segmental flexibility is important for TcE function, but adding additional degrees of freedom throughtransformats has a cost for killing efficiency that may be explained by failure of close contact formation and integrin activation.

BACKGROUND AND AIMS Individuals living with chronic kidney disease (CKD) are at greater risk of sustaining hip fractures compared with the general population. Following acute trauma, CKD patients are susceptible to lengthened hospitalization with their clinical condition exacerbated by frailty, co-morbidities and sarcopaenia. The most useful clinical assessment tools to predict lengthened in-hospital stays in patients with CKD following admission with hip fracture remain unestablished. METHOD Patients with CKD G3b-5 admitted from home to a tertiary centre hospital in North West UK with hip fracture between Jun 2013 and Jun 2020 were evaluated. Lengthened hospitalization is determined by >2 weeks of in-hospital stay in our analysis, given the average length of in-hospital stay is ∼14 days for the CKD population following hip fracture. Clinical assessment tools used in admission assessment for each patient included the Clinical Frailty Scale (CFS), Charlson's Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Karnofsky's Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, Estimated VO2 Peak, ASA Physical Status Classification System Score and the Abbreviated Mental Test Score. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual clinical assessment tools to predict for >2 weeks of in-hospital stay in patients with CKD admitted following hip fracture. RESULTS A total of 539 patients with CKDG3b-5 were admitted following hip fracture throughout the study period, of which 329 patients had >2 weeks of in-hospital stay. Within the cohort with >2 weeks of in-hospital stay, mean age was 84.4 ± 10.6 years. The female: male ratio was 1.6:1. Of those, 47 patients (14.3%) were on long-term dialysis. For this cohort, 30-day, 6-month and 1-year mortality were 6.7%, 14.9% and 43.2%, respectively. The odds ratio (OR) for 30-day {OR: 1.71, [95% confidence interval (95% CI) 1.04–2.39]; P < .01}, 6-month (OR: 2.06, 95% CI 1.38–2.73; P < .01) and 1-year mortality (OR: 2.62, 95% CI 1.95–3.30; P < .01) was significantly higher in CKD patients with > 2 weeks of in-hospital stay following hip fracture compared with those who were discharged within the first 2 weeks of hospitalization. Area Under the Curve (AUC) values from ROC analyses for individual clinical assessment tools are shown in Table 1. CONCLUSION Frailty and co-morbidity clinical assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for lengthened in-hospital stays in patients living with CKD admitted following hip fracture. CKD patients with lengthened in-hospital stays following hip fracture have greater risks of acute in-hospital mortality and mortality over the short- to medium-term following discharge. Research initiatives should continue to evaluate multidisciplinary management strategies for the older CKD population following acute trauma. Reducing the length of hospitalization may improve survival outcomes and alleviate costs and public health burdens in the care of the older CKD population.

Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

Purpose Despite the importance of accountability for the oversight of projects, few studies have directly examined accountability mechanisms at the project level. While the literature already provides descriptions of governance and mechanisms of accountability, the purpose of this paper is to examine how project managers view their accountability relationships within their organizational context. Design/methodology/approach The study is guided by critical realism as a philosophy of science. The authors interviewed 15 project managers from 12 organizations and analyzed the transcripts in the light of existing project management accountability literature. Findings The authors observe the practice of socializing accountability through face-to-face negotiation and symmetries of power due to interdependencies happen to some extent in management of projects. This suggests ambidexterity in accountability in project-based organizations. Therefore, the current models of project accountability and governance that are solely based on the agency theory are not sufficient to explain the accountability relationships in such organizations. Practical implications Accountability arrangements happen within a system for steering projects. Managers should be aware of how project managers view their accountability and how socializing practices of accountability can help the project’s management and the organization’s management interact in order to transform organizational systems by regulating issues of project concern and defining the process and direction of how project deliverables are produced, introduced, absorbed and used within the organization. Originality/value “Theory driven” interviews and analysis are used to confirm or refine conceptualization of accountability in management of projects. Most models of project governance are based on the agency theory or governability theory. The authors have demonstrated that socializing practices of accountability should be included in investigating project governance. The authors observe that project managers are often concerned with the interdependence with their principals and the socializing processes of accountability that arise from this interdependence.

Publication in the list of 50 journals endorsed by the Financial Times (i.e., the FT50) has become ‘institutionalized’ as a primary measure of research quality and prestige by business schools and faculty. This study investigated the extent to which this closed publication system is (mis)aligned with societal imperatives, in particular the United Nation’s 17 Sustainable Development Goals (SDGs). Research methods included both inductive and deductive analysis. Undergraduate and graduate student research assistants, enrolled in business-related programs, read all 4522 articles published by FT50 journals in 2019 and assessed their relevance to explicit and implicit concepts in the SDG framework. Additionally, potential biases that might stifle research innovation in support of the SDGs were explored. Findings included that 90% of articles were found to have no ‘explicit’ relationship to the SDGs, while only 17% were interpreted as having an implicit relationship. SDG-related articles were disproportionately from one journal-the Journal of Business Ethics (48.1%). There was also an over-representation of observed white male primary authors, who used North American (NA) data sets from NA institutions. A logistic regression model determined that the predicted probability of an SDG-related article increased with observed female primary authors, who used non-NA data sets and institutions. The next steps include comparing this methodological approach with machine learning techniques to find a more efficient and robust method for analyzing an article’s SDG content. Business Schools with sustainability as a core value are encouraged to move beyond FT50 publications for assessing research quality, including for tenure and promotion purposes, and place more focus on assessing research relevance and impact.

An increasing demand for in-center dialysis services has been largely driven by a rapid growth of the older population progressing to end-stage kidney disease. Since the onset of the COVID-19 pandemic, efforts to encourage home-based dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center-based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population.

Background Neoadjuvant chemoradiation with fluoropyrimidine followed by surgery and adjuvant chemotherapy has been the standard treatment of locally advanced stages II and III rectal cancer for many years. There is a high risk for disease recurrence; therefore, optimizing chemoradiation strategies remains an unmet need. Based on a few studies, there is evidence of the synergistic effect of VEGF/PDGFR blockade with radiation. Methods In this phase I, dose-escalation and dose-expansion study, we studied 3 different dose levels of lenvatinib in combination with capecitabine-based chemoradiation for locally advanced rectal cancer. Results A total of 20 patients were enrolled, and 19 were eligible for assessment of efficacy. The combination was well tolerated, with an MTD of 24 mg lenvatinib. The downstaging rate for the cohort and the pCR was 84.2% and 37.8%, respectively. Blood-based protein biomarkers TSP-2, VEGF-R3, and VEGF correlated with NAR score and were also differentially expressed between response categories. The NAR, or neoadjuvant rectal score, encompasses cT clinical tumor stage, pT pathological tumor stage, and pN pathological nodal stage and provides a continuous variable for evaluating clinical trial outcomes. Conclusion The combination of lenvatinib with capecitabine and radiation in locally advanced rectal cancer was found to be safe and tolerable, and potential blood-based biomarkers were identified. Clinical Trial Registration NCT02935309

Background and Aims Frailty is highly prevalent in adults with chronic kidney disease (CKD) and is associated with adverse health outcomes. However, exercise training may improve physical function leading to associated improvements in outcomes. The EX-FRAIL CKD trial (ISRCTN87708989) aimed to inform the design of a randomised controlled trial (RCT) that investigates the efficacy of a progressive home-based exercise programme in pre-frail and frail older adults with CKD. Methods Patients aged ≥65 years with CKD G3b-5 and a Clinical Frailty Scale score ≥4 were eligible for participation. Participants categorised as pre-frail or frail, following Frailty Phenotype (FP) assessment, were randomised to receive a tailored 12-week home-based exercise programme or usual care (UC). Primary outcome measures included recruitment, intervention adherence, outcome measure completion and participant attrition rate. Secondary outcome measures included frailty status (FP), physical function (walking speed, handgrip strength and Short Physical Performance Battery [SPPB]), fall concern (Falls Efficacy Scale-International tool [FESI]), symptom-burden (Palliative Care Outcome Scale-Symptoms RENAL [POS-S RENAL]) and health-related quality of life (Short Form-12v2 [SF-12]). Outcome measures are reported descriptively with 95% confidence intervals (CI) as recommended for pilot trials. Progression criteria to RCT stage were defined as: (1) eligibility: STOP 10%; (2) recruitment: STOP 30%; (3) exercise adherence: STOP: 70%; (4) outcome measure completion: STOP 80%; and (5) loss to follow-up: STOP >50%, GO Results Six hundred and sixty-five participants had an eligibility assessment with 201 (30% [95% CI 27-34]) patients eligible for enrolment. Thirty-five (17% [95% CI 12-23]) participants were recruited. Six participants were categorised as robust and therefore withdrawn prior to randomisation. Fifteen participants were randomised to exercise (mean age 77.0±8.3 years; mean eGFR 18.9±7.0 ml/min/1.73m2) and 14 to UC (mean age 78.8±7.0 years; mean eGFR 20.4±7.2 ml/min/1.73m2). Eleven (73% [95% CI 45-92]) exercise group participants completed an average of ≥2 exercise sessions/week. Eight (28% [95% CI 13-47]) participants were lost to follow-up. Retained participants (n=21, 100% [95% CI 84-100]) completed all outcome measures. There were 32 adverse events in the exercise group and 22 in the UC group. Within the exercise group, there were 2 hospitalisations (considered unrelated to exercise) and 12 adverse reactions: musculoskeletal pain (9), fall (1), nocturnal leg cramps (1) and postural dizziness (1). The odds ratio for improvement in frailty status with exercise was 5.50 (95% CI 0.46-65.16) and odds ratio for deterioration in frailty status was 0.63 (95% CI 0.05-8.20). The adjusted mean group difference in walking speed, grip strength and SPPB between exercise and UC groups were: 0.01 metres/second (95% CI -0.07-0.10), 3.6 kg (95% CI -0.6-7.9) and 0.5 (95% CI -0.9-1.8), respectively. The adjusted mean group difference in POS-S RENAL, FESI, SF-12 Physical Component Summary and SF-12 Mental Component Summary scores were: -1.4 (95% CI -6.6-3.7), 3.4 (95% CI -3.5-10.3), -3.9 (95% CI -9.3-1.5) and 0.2 (95% CI -6.2-6.6), respectively. Conclusion Eligibility, adherence and outcome measure progression criteria thresholds were exceeded; however, recruitment and loss to follow-up progression criteria thresholds were not achieved. Analysis of a nested qualitative study will explore perceived barriers to participation and retention. The EX-FRAIL CKD trial demonstrates that it is possible to progress to a definitive RCT with adaptations that address the barriers described. It has also provided preliminary evidence that frailty status and physical function may be improved with a home-based exercise programme in patients living with frailty and CKD.

Background Frailty is independently associated with worse health-related quality of life (HRQOL) in chronic kidney disease (CKD). However, the relationship between frailty and symptom experience is not well described in people living with CKD. This study’s aim was to evaluate the relationship between frailty and symptom-burden in CKD. Methods This study is a secondary analysis of a cross-sectional observational study, the QCKD study (ISRCTN87066351), in which participants completed physical activity, cardiopulmonary fitness, symptom-burden and HRQOL questionnaires. A modified version of the Frailty Phenotype, comprising 3 self-report components, was created to assess frailty status. Multiple linear regression was performed to assess the association between symptom-burden/HRQOL and frailty. Logistic regression was performed to assess the association between experiencing symptoms frequently and frailty. Principal Component Analysis was used to assess the experienced symptom clusters. Results A total of 353 patients with CKD were recruited with 225 (64%) participants categorised as frail. Frail participants reported more symptoms, had higher symptom scores and worse HRQOL scores. Frailty was independently associated with higher total symptom score and lower HRQOL scores. Frailty was also independently associated with higher odds of frequently experiencing 9 out of 12 reported symptoms. Finally, frail participants experienced an additional symptom cluster that included loss of appetite, tiredness, feeling cold and poor concentration. Conclusions Frailty is independently associated with high symptom-burden and poor HRQOL in CKD. Moreover, people living with frailty and CKD have a distinctive symptom experience. Proactive interventions are needed that can effectively identify and address problematic symptoms to mitigate their impact on HRQOL.

Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.

Background/Aims: Frail patients with chronic kidney disease (CKD) have an increased hospitalisation and mortality rate. However, many popular frailty screening methods have not been validated in patients with CKD. This study evaluates the diagnostic accuracy of several frailty screening methods in patients with CKD G4–5 and those established on haemodialysis (G5D). Methods: Ninety participants with CKD G4–5D were recruited from Nephrology Outpatient Clinics and 2 Haemodialysis Units between December 2016 and December 2017. Frailty was diagnosed using the Fried Frailty Phenotype. The following frailty screening tests were evaluated: Clinical Frailty Scale, PRISMA-7, CKD Frailty Index, CKD FI-LAB, walking speed, hand grip strength and Short Physical Performance Battery. Results: The mean age of participants was 69 years (SD ±13). One-third of participants were dialysis-dependent. Nineteen (21%) patients were categorised as frail, 42 (47%) as pre-frail and 29 (32%) as robust. Overall, walking speed was the most discriminative measure (AUC 0.97 [95% CI 0.93–1.00], sensitivity 0.84 [95% CI 0.62–0.94], specificity 0.96 [95% CI 0.88–0.99]). The Clinical Frailty Scale had the best performance of the non-physical assessment frailty screening methods (AUC 0.90 [95% CI 0.84–0.97], sensitivity 0.79 [95% CI 0.57–0.91], specificity 0.87 [95% CI 0.78–0.93]). Conclusions: Walking speed can be used to accurately screen for frailty in CKD populations. If it is not practical to perform a physical assessment to screen for frailty, the Clinical Frailty Scale is a useful alternative.

Weak protein–protein interactions may be important to binding cooperativity. A panel of seven fluorescently labeled tracer monoclonal IgG antibodies, differing in variable (V) and constant (C) region sequences, were sedimented in increasing concentrations of unlabeled IgGs of identical, similar, and different backgrounds. Weak IgG::IgG attractive interactions were detected and characterized by global analysis of the hydrodynamic nonideality coefficient, k (s). The effects of salt concentration and temperature on k (s) suggest the interactions are predominantly enthalpic in origin. The interactions were found to be variable in strength, affected by both the variable and constant regions, but indiscriminate with respect to IgG subclass. Furthermore, weak attractive interactions were observed for all the mAbs with freshly purified human poly‐IgG. The universality of the weak interactions suggest that they may contribute to effector function cooperativity in the normal immune response, and we postulate that the generality of the interactions allows for a broader range of epitope spacing for complement activation. These studies demonstrate the utility of analytical ultracentrifuge fluorescence detection in measuring weak protein–protein interactions. It also shows the strength of global analysis of sedimentation velocity data by SEDANAL to extract hydrodynamic nonideality k (s) to characterize weak macromolecular interactions.

Rituximab, an anti-CD20 monoclonal antibody, was originally used to treat B-cell malignancies. Its use has significantly increased in recent years, as it is now also used to treat a variety of autoimmune diseases including rheumatoid arthritis and ANCA-associated vasculitis (AAV). Initial studies suggested that the adverse effects of rituximab were minimal. Though the risk of malignancy with rituximab-based immunosuppressive regimens appears similar to that of the general population, there are now concerns regarding the risk of infectious complications. Rituximab has been associated with serious infections, including Pneumocystis jiroveci pneumonia (PJP) and the reactivation of hepatitis B virus (HBV) and tuberculosis (TB). The risk of infection appears to be the result of a variety of mechanisms, including prolonged B-cell depletion, B-cell–T-cell crosstalk, panhypogammaglobulinaemia, late-onset neutropenia and blunting of the immune response after vaccination. Importantly, the risk of infectious complications is also related to individual patient characteristics and the indication for rituximab. Individualization of treatment is, therefore, crucial. Particular attention should be given to strategies to minimize the risk of infectious complications, including vaccinating against bacterial and viral pathogens, monitoring white cell count and immunoglobulin levels, prophylaxis against PJP and screening for HBV and TB.

Two patients developed kidney failure due to oxalate deposition in the kidney while taking orlistat. Cessation of orlistat was followed by partial recovery of kidney function. The mechanism by which orlistat causes hyperoxaluria and the management of orlistat-induced oxalate nephropathy is reviewed. We suggest that all patients taking orlistat are at risk of this condition, which may develop insidiously and is easily overlooked. Monitoring of kidney function of patients taking orlistat is warranted.

Liver impairment is a recognised adverse effect of long-term sodium valproate treatment, but there are few reports concerning its occurrence after acute overdose. This report describes a 36-year-old woman who deliberately ingested 32 g of sodium valproate (Epilim). Serum valproate concentration was 4370 μmol/l (630 mg/l) at 4.3 h post-ingestion (therapeutic reference range: 300–600 μmol/l), and the elimination half-life was 14.1 h. Liver biochemistry tests were initially normal but gradually became impaired, and highest alanine aminotransferase (761 U/l) occurred 2.3 days after ingestion. Supportive measures alone were sufficient to allow recovery of liver function. This case indicates that sodium valproate overdose may cause acute hepatocellular injury, even in the absence of pre-existing liver disease.

Background and aims: self-poisoning accounts for a substantial proportion of acute medical hospital presentations, but has been poorly characterised in older adults. This study sought to determine the agents ingested by older adults presenting to hospital after drug overdose, and to compare clinical outcomes to younger patients. Methods: a retrospective observational study of patients admitted via the emergency department due to drug overdose between 2004 and 2007. Results: during the study period, there were 8,059 admissions, including 4,632 women (57.5%). This included a subgroup of 361 patients (4.5%) who were >60 years of age. This subgroup was more likely to require hospital stay >1 night, odds ratio (95% confidence interval) = 4.3 (3.6‐5.5, P < 0.0001), transfer to a critical care area = 3.8 (1.1‐13.0, P = 0.0340) and had higher mortality = 4.8 (1.1‐22.1, P = 0.0463). A higher proportion of older patients required transfer to a psychiatric unit (P < 0.0001) or to a general medical ward (P < 0.0001) than younger adults. Conclusions: older adults that presented to hospital after drug overdose had ingested different drugs than younger patients, possibly due to different prescribing patterns, and had a poorer outcome. The use of drugs associated with significant toxicity should be avoided in older patients at risk of self-harm.

Antiepileptic drugs are increasingly used in patients with psychiatric disorders who are at increased risk of self-harm. This might increase the likelihood that these agents are used as a means of overdose. This study was designed to examine the rate of occurrence of antiepileptic drug overdose between 2000 and 2007.A retrospective observational study examined patterns of antiepileptic drug overdose in patients admitted to the Edinburgh Poisons Unit, and compared prescription data for the corresponding region. Data were compared using chi-square trend tests.There were 18 010 admissions to the Toxicology Unit, and 613 patients ingested at least one antiepileptic drug (3.4%). The most frequently implicated were carbamazepine, sodium valproate, phenytoin and lamotrigine, which corresponded with those most commonly prescribed. Women were more likely to ingest lamotrigine than men (P0.0001), and less likely to ingest sodium valproate (P = 0.0234). Patients that ingested antiepileptic drugs were more likely to be admitted to hospital for1 day (22% vs. 8%, P0.0001) and need transfer to a psychiatric facility (14% vs. 7%, P0.0001).Patients that ingested antiepileptic drugs required more intensive medical and psychiatric intervention compared to ingestion of other agents. Significant gender differences were noted in the specific antiepileptic drug ingested. Further work is required to establish whether this discrepancy may be explained by gender-based prescribing practices.

Background and Aims Patients with chronic kidney disease (CKD) report high symptom-burden that adversely affects health-related quality of life (HRQOL). Frailty is an independent predictor of poor HRQOL in those with CKD. Although there is a clear relationship between frailty and HRQOL in patients with CKD, the associated relationship with symptom experience is not well understood. Understanding how living with both frailty and CKD influences symptom-burden could inform management strategies that improve HRQOL of this vulnerable patient group. This study’s aim was to evaluate the symptom experience of patients living with frailty and CKD. Methods A total of 353 participants were recruited between February 2018 and October 2018 to this cross-sectional observational study. Participants completed physical activity (GP Physical Activity Questionnaire [GPPAQ]), cardiopulmonary fitness (Duke Activity Status Index, providing estimated VO2 peak), symptom-burden (Kidney Symptom Questionnaire [KSQ]) and HRQOL (Short Form 12 [SF-12]) questionnaires. Frailty was assessed using a modified Frailty Phenotype comprising 3 self-report components: 1) weakness/slowness defined as a SF-12 Physical Functioning score Results Two hundred and twenty-five (64%) participants were categorised as frail. Frail participants were significantly older (77.7 vs. 71.5 years, p Conclusion Frailty is an independent predictor of high symptom-burden and poor HRQOL. Furthermore, symptom experience for people living with frailty and CKD is distinct from non-frail individuals, reporting a unique symptom cluster that may be a consequence of the frailty syndrome itself. This group of patients should be offered a holistic assessment so that problematic symptoms can be identified and addressed early before they impact more significantly on HRQOL. Future efforts should be focused on evaluating holistic models of care, such as the comprehensive geriatric assessment, for patients living with frailty and CKD.